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(2) ACTION
NEEDED TO STOP "DISEASE
MONGERING"
(3) MEDICALISING
SEX DAMAGES
RELATIONSHIPS
(4) DOES
DIRECT TO CONSUMER DRUG
ADVERTISING
MEDICALISE NORMAL
HUMAN CONDITIONS?
(5) GENETIC
TESTS COULD DEFINE US ALL AS
PATIENTS
(6) MANY
JUNIOR DOCTORS EXPERIENCE
BULLYING
(1) WHAT IS AND WHAT IS NOT A DISEASE?
(In search of "non-disease" )
http://bmj.com/cgi/content/full/324/7342/883
What is and what is not a disease? The
BMJ recently
ran a vote on bmj.com to identify "non-diseases".
The
aim was to prompt a debate on what is
and what is
not a disease and draw attention to the
increasing
tendency to classify people's problems
as diseases.
A top 20 list includes ageing, baldness,
jet lag,
cellulite, and anxiety about penis size.
Some of these
"non-diseases" already appear in official
classifications
of disease.
To have your condition labelled as a disease
may
bring considerable benefit, writes BMJ
Editor,
Richard Smith. Immediately you are likely
to enjoy
sympathy rather than blame, and you may
be
exempted from many commitments, including
work.
You may also feel that you have an explanation
for
your suffering.
But the diagnosis of a disease may also
create
problems. You may be denied insurance,
a mortgage,
and employment. Some diseases carry an
inescapable
stigma, which may create more problems
than the
disease itself. Worst of all, the diagnosis
may lead you
to regard yourself as forever flawed and
incapable of
"rising above" your problem.
We are not suggesting that the suffering
of people with
these "non-diseases" is not genuine, he
says, but surely
everything is to be gained and nothing
lost by raising
consciousness about the slipperiness of
the concept of
disease.
(2) ACTION NEEDED
TO STOP "DISEASE
MONGERING"
(Selling sickness: the pharmaceutical
industry and
disease mongering)
http://bmj.com/cgi/content/full/324/7342/886
A lot of money can be made from telling
healthy
people they're sick despite clear conflicts
of interest.
Pharmaceutical companies sponsor disease
definitions
and promote them to prescribers and consumers.
In
this week's BMJ researchers give examples
of
"disease mongering" and suggest how to
prevent the
growth of this practice.
Some forms of medicalising ordinary life
may be
better described as "disease mongering"
? extending
the boundaries of treatable illness to
expand markets
for new products.
Disease mongering can include turning ordinary
processes or ailments into medical problems.
For
example, around the time that Merck's
hair growth
drug finasteride (Propecia) was first
approved in
Australia, leading newspapers featured
new
information about the emotional trauma
associated
with hair loss, say the authors.
Disease mongering can also include seeing
mild
symptoms as serious, and treating personal
problems
as medical ones: A senior Roche official
tells the
authors that company promotion exaggerated
the level
of social phobia in Australia.
Risks are increasingly portrayed as diseases,
according to the authors, citing the example
of
corporate backed promotional activities
for
osteoporosis which attempt to persuade
millions of
healthy women worldwide that they are
sick.
Although these observations of disease
mongering are
selective and preliminary, the authors
believe that
more could be done to expose and reduce
misleading
"wonder drug" stories in the media, which
help to
facilitate so much disease mongering.
They suggest
that corporate funded information about
disease
should be replaced by independent information.
Contact:
Ray Moynihan, Journalist, Australian Financial
Review, Sydney, Australia
Email: ray_128@hotmail.com
(3) MEDICALISING
SEX DAMAGES
RELATIONSHIPS
(Sexual behaviour and its medicalisation:
in sickness
and in health)
http://bmj.com/cgi/content/full/324/7342/896
Overly medical approaches to sex ignore
the social
and interpersonal dynamics of relationships,
argue
researchers in this week's BMJ.
The medicalisation of sex has resulted
in surgery and
drugs being used to enhance sexual pleasure,
write
Graham Hart and Kaye Wellings. Viagra
(sildenafil
citrate) has become the world's most popular
drug
ever, and gynaecological surgery is also
being
harnessed to enhance female sexual pleasure
and
improve aesthetics.
In America, erectile dysfunction is estimated
to affect
half of men aged 40-70 and 70% of men
over 70.
This high level of sexual dysfunction
may simply reflect
people's expectations and feelings of
inadequacy in
the light of the escalating sexualisation
of our culture,
they add.
The problem with an overly medical approach
to
sexual behaviour is that social and interpersonal
dynamics may be ignored, say the authors.
The last
century saw a considerable increase in
acceptance of
diversity of sexual expression. It would
be a shame if
this century saw diversity replaced by
uniform
expectations of performance and desire,
they
conclude.
Contacts:
Graham Hart, Professor, MRC Social and
Public
Health Sciences Unit, University of Glasgow,
Scotland
Email: g.hart@msoc.mrc.gla.ac.uk
Kaye Wellings, Head of Centre for Sexual
Health
Research, London School of Hygiene &
Tropical
Medicine, London, UK
Email: kaye.wellings@lshtm.ac.uk
(4) DOES DIRECT
TO CONSUMER DRUG
ADVERTISING MEDICALISE NORMAL
HUMAN CONDITIONS?
(For and against: Direct to consumer
advertising is
medicalising normal human experience)
http://bmj.com/cgi/content/full/324/7342/908
Does direct to consumer advertising of
prescription
drugs, currently allowed only in the United
States and
New Zealand, medicalise normal human conditions?
A debate in this week's BMJ puts the case
for and
against.
Direct to consumer advertising encourages
healthy
people to believe they need medical attention,
writes
Barbara Mintzes at the University of British
Columbia.
Relatively healthy people are targeted
because of the
need for adequate returns on costly advertising
campaigns.
Advertising campaigns can lead to shifts
in the pattern
of use of healthcare services. In 1998,
during a
campaign for finasteride (Propecia), visits
to US
doctors for baldness increased by 79%
compared
with 1997 levels, to 850,000. Even when
the focus in
on prevention of serious disease, many
advertising
campaigns cast too wide a net, adds the
author
In late 1999, Americans on average saw
nine
prescription drug advertisements a day
on television.
"To an unprecedented degree, they portrayed
the
educational message of a pill for every
ill ? and
increasingly an ill for every pill," she
concludes.
Evidence shows a substantial under-diagnosis
of many
of the major diseases and known risk factors
for
which effective treatments exist, argue
Silvia
Bonaccorso and Jeffrey Sturchio of the
pharmaceutical company, Merck.
At the moment, the pharmaceutical industry,
which
has perhaps the best information on the
medicines
they make, is constrained in Europe from
communicating this directly to consumers,
whereas
other people and organisations are free
to disseminate
information of perhaps dubious quality.
To limit access to product information
arbitrarily
because of unfounded fears about direct
to consumer
advertising impinges on the rights of
Europeans to
have all the information they need to
make informed
choices about their health, they conclude.
Contacts:
Barbara Mintzes, Graduate Researcher, Centre
for
Health Services and Policy Research, University
of
British Columbia, Vancouver, Canada
Email: bmintzes@chspr.ubc.ca
Silvia Bonaccorso, Vice President, Marketing
and
Medical Services, Merck, Whitehouse Station,
NJ,
USA
Email: silvia_bonaccorso@merck.com
(5) GENETIC TESTS
COULD DEFINE US ALL AS
PATIENTS
(Editorial: Genetics and medicalisation)
http://bmj.com/cgi/content/full/324/7342/863
Genetic science could drive a new wave
of
medicalisation if genetics tests are accepted
without
appropriate evaluation, warn researchers
in this
week's BMJ.
David Melzer and Ron Zimmern argue that
genetic
tests for markers that may not result
in symptoms for
half a century or more could be new examples
of a
process of premature medicalisation. This
would
occur if "disease" labels were attached
to people
before it had been established precisely
what each test
result predicts and whether prevention
or treatment
for the specific genetic difference was
beneficial.
Unless it is established that a genetic
variant is a
pointer to beneficial action, there is
a potential for
inappropriate medicalisation through the
spread of
poorly understood tests, say the authors.
The
perceptions of risk resulting from such
tests may bear
little relation to the scientific facts
and uncertainties.
Inflated ideas about risks could result
in people
carrying such genes being treated unfairly
in many
areas, including employment or insurance,
they
suggest.
The enormous investments needed to exploit
genetics
may have driven a more exuberant set of
claims than
usual, designed to appeal not only to
the public but
also to investors, say the authors. The
antidote lies in
remaining sceptical and level headed.
Genetic technologies have the potential
to be of major
benefit to society, but their introduction
must be
measured, attentive to social and ethical
considerations and, most importantly,
based on good
evidence, they conclude.
Contacts:
David Melzer, Clinical Senior Research
Associate,
Department of Public Health and Primary
are,
University of Cambridge, Cambridge, UK
Email: dm214@medschl.cam.ac.uk
Ron Zimmern, Director, Public Health Genetics
Unit,
Cambridge, UK
Email: ron.zimmern@srl.cam.ac.uk
(6) MANY JUNIOR
DOCTORS EXPERIENCE
BULLYING
(Workplace bullying in junior doctors:
questionnaire
survey)
http://bmj.com/cgi/content/full/324/7342/878
Many junior doctors in the United Kingdom
experience bullying during training, finds
a study in this
week's BMJ.
An anonymous questionnaire was sent to
1,000
doctors with job grades from house officer
to senior
registrar. Participants were presented
with a definition
of bullying and asked to indicate whether
they had
been subjected to it in the past 12 months
and
whether they had witnessed others being
bullied.
Of 594 completed questionnaires, 220 (37%)
reported being bullied in the past year
and 84% had
experienced at least one bullying behaviour.
Black and
Asian doctors were more likely to be bullied
than
white doctors, and women were more likely
to report
being bullied than men. Reports of bullying
did not
vary by job grade or age.
These findings should be interpreted cautiously
as the
study relied on self reports of bullying,
and a higher
response rate would have been desirable,
say the
researchers. Nevertheless, the findings
suggest that
disturbingly high levels of bullying and
mistreatment
during training are part of many junior
doctors'
perceptions and experiences, they conclude.
Contact:
Lyn Quine, Reader in Health Psychology,
Department
of Psychology, University of Kent at Canterbury,
Canterbury, UK
Email: L.Quine@ukc.ac.uk
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